邮件订阅 RSS

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

髋关节手术新型麻醉方式:腰丛、坐骨神经及椎旁神经联合阻滞

阮侠,  徐仲煌

downloadPDF
文章导航 > 协和医学杂志  > 2011 >  2(4): 326-330
阮侠, 徐仲煌. 髋关节手术新型麻醉方式:腰丛、坐骨神经及椎旁神经联合阻滞[J]. 协和医学杂志, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
引用本文: 阮侠, 徐仲煌. 髋关节手术新型麻醉方式:腰丛、坐骨神经及椎旁神经联合阻滞[J]. 协和医学杂志, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
shu
Xia RUAN, Zhong-huang XU. Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
Citation: Xia RUAN, Zhong-huang XU. Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
shu

髋关节手术新型麻醉方式:腰丛、坐骨神经及椎旁神经联合阻滞

doi: 10.3969/j.issn.1674-9081.2011.04.009

  • 中国医学科学院 北京协和医学院 北京协和医院麻醉科, 北京 100730

详细信息
    通讯作者:

    徐仲煌 电话:010-65295580, E-mail:zhonghuangxu@yahoo.com.cn

  • 中图分类号: R614.4;R687.4

Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty

  • Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  评估腰丛+坐骨神经联合椎旁神经阻滞在人工髋关节置换术中的应用价值。  方法  回顾性分析34例行人工髋关节置换手术的患者, 根据不同麻醉方式分为全身麻醉组(GA组)、硬膜外组(EA组)和外周神经阻滞组(NB组), NB组进一步分为腰丛+坐骨神经阻滞组(LS组)和腰丛+坐骨神经+椎旁神经阻滞组(PVB), 比较各组患者的围手术期情况。  结果  NB组患者平均年龄和术前合并疾病发生率明显高于其他两组(P < 0.05), NB组患者术中收缩压、舒张压和心率最大变化率分别为13.9%±6.1%、15.8%±8.2%和14.0%±4.7%, 明显低于GA组的21.6%±7.0%、23.3%±7.2%和23.3%±7.8%(P < 0.05)。NB组患者术中芬太尼使用量为(103.8±42.7)μg, 显著低于GA组的(295.0±55.4)μg(P < 0.05)。与LS组比较, PVB组患者收缩压和舒张压的最大变化率显著减低, 分别为9.0%±3.4% vs.18.8%±3.3%和9.0%±4.1% vs.22.5%±4.2%(P < 0.05);芬太尼用量减少, PVB组为(87.5±47.9)μg, LS组为(120.0±35.6)μg, 但两组比较差异无统计学意义(P > 0.05)。  结论  外周神经阻滞复合小剂量静脉麻醉可以安全有效地用于人工髋关节置换术, 腰丛+坐骨神经复合椎旁神经阻滞可进一步增加外周神经阻滞的阻滞效果。
    Abstract:   Objective  To evaluate the value of lumber plexus + sciatic nerve + paravertebral nerve block as an anesthesia technique for hip arthroplasty surgery.  Methods  We retrospectively analyzed the perioperative data of 34 patients scheduled for a hip arthroplasty surgery. According to the different anesthesia techniques applied, patients were divided into 3 groups:general anesthesia (GA) group, epidural anesthesia (EA) group, and nerve block (NB) group. Patients in NB group were further divided into lumber plexus + sciatic nerve block (LS) group and lumber plexus + sciatic nerve + paravertebral nerve block (PVB) group.  Results  The average age and the incidence of coexisting disease in NB group were significantly higher than those in GA and EA group (P < 0.05). Significant decreases in the variation of systolic blood pressure, diastolic blood pressure and heart rate in NB group were observed compared with GA group (13.9%±6.1% vs. 21.6%±7.0%, 15.8%±8.2% vs. 23.3%±7.2%, 14.0%±4.7% vs. 23.3%±7.8%, all P < 0.05), and the intra-operative dosage of fentanyl was significantly lower[(103.8±42.7) μg vs. (295.0±55.4) μg, P < 0.05]. Compared with LS group, the variations of systolic blood pressure and diastolic blood pressure significantly reduced in PVB group (9.0%±3.4% vs. 18.8%±3.3%; 9.0%±4.1% vs. 22.5%±4.2%, P < 0.05), and the fentanyl consumption was lower but without a significant difference[(87.5±47.9) μg vs. (120.0±35.6) μg, P > 0.05].  Conclusions  Peripheral nerve block combined with small-dose intravenous anesthesia is a safe and effective anesthetic technique for hip arthroplasty surgery, and lumbar plexus + sciatic nerve + paravertebral nerve block probably can be a more effective regional anesthetic technique.
    • HTML全文

  • 表  1  三组患者一般资料

    组别 n 年龄(岁) 性别(男/女) ASA分级(1 /2 /3 /4) 手术时间(min)
    GA 16 61. 8 ± 16. 6 5 /11 1 /12 /3 /0 117 ± 27
    EA 10 58. 0 ± 11. 3 7 /3 3 /7 /0 /0 115 ± 37
    NB 8 75. 1 ± 11. 5* 3 /5 0 /5 /2 /1 93 ± 24
    ASA:美国麻醉医师协会; GA:全身麻醉; EA:连续硬膜外麻醉; NB:外周神经阻滞与GA及EA组比较，* P＜0. 05
    下载: 导出CSV

    表  2  三组患者术中血流动力学变化

    组别 麻醉前即刻   切皮时   最大变化率
    SBP (mm Hg) DBP (mm Hg) HR (bpm)   SBP (mm Hg) DBP (mm Hg) HR (bpm)   SBP (%) DBP (%) HR (%)
    GA 132. 2 ± 17. 1 79. 1 ± 11. 1 73. 9 ± 8. 7   114. 1 ± 10. 0 68. 1 ± 7. 9 68. 4 ± 7. 0   21. 6 ± 7. 0 23. 3 ± 7. 2 23. 3 ± 7. 8
    EA 133. 0 ± 11. 1 82. 0 ± 7. 9 79. 4 ± 7. 2   120. 5 ± 6. 9 75. 5 ± 7. 6 72. 6 ± 11. 9   16. 1 ± 7. 1 25. 3 ± 9. 4 18. 2 ± 5. 2
    NB 138. 8 ± 24. 2 74. 4 ± 16. 8 80. 6 ± 6. 9   122. 5 ± 19. 8 68. 8 ± 14. 3 76. 5 ± 9. 9   13. 9 ± 6. 1* 15. 8 ± 8. 2* † 14. 0 ± 4. 7*
    GA，EA，NB:同表 1; SBP:收缩压; DBP:舒张压; HR:心率与GA组比较，* P＜0. 05;与EA组比较，†P＜0. 05
    下载: 导出CSV
    • 参考文献(14)
  • [1] 徐仲煌, 黄宇光, 任洪智.神经刺激器定位神经阻滞在临床麻醉中的应用[J].临床麻醉学杂志, 2001, 17:278-279. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz200105017
    [2] 徐仲煌, 唐帅, 罗爱伦, 等.腰丛神经阻滞在高龄患者髋关节手术中的应用[J].中国医学科学院学报, 2010, 32:328-331. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyxkxyxb201003019
    [3] Pagnano MW, Hebl J, Horlocker T. Assuring a painless total hip arthroplasty:a Multimodal approach emphasizing peripheral nerve blocks[J]. J Arthroplasty, 2006, 21(4 Suppl 1):80-84. http://www.europepmc.org/abstract/MED/16781436
    [4] Dauphin A, Raymer KE, Stanton EB, et al. Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty:effects of epidural blocks on epidural arthroplasty[J]. J Clin Anesth, 1997, 9:200-203. doi:  10.1016/S0952-8180(97)00035-4
    [5] Davis FM, Laurenson VG, Gillespie WJ. Deep vein thrombosis after total hip replacement:a comparison between spinal and general anaesthesia[J]. J Bone Joint Surg, 1989, 71B:181-185. http://europepmc.org/abstract/med/2925731
    [6] Modig J. Influence of regional anesthesia, local anesthetics, and sympathicomimetics on the pathophysiology of deep vein thrombosis[J]. Acta Chir Scand, 1989, 550:119-127. http://www.ncbi.nlm.nih.gov/pubmed/2652963
    [7] 3rd BCC, Xenos JS, Nilsen SM. Lumbar plexus block with perineural catheter and sciatic nerve block for total hip arthroplasty[J]. J Arthroplasty, 2002, 17:499-502. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=2dbebb143081c2c5437e2b8f24170a17
    [8] de Leeuw MA, Slagt C, Hoeksema M, et al. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery[J]. Anesth Analg, 2011, 112:719-724. doi:  10.1213/ANE.0b013e318206bc30
    [9] Duarte LT, Beraldo PS, Saraiva RA. Epidural lumbar block or lumbar plexus block combined with general anesthesia:efficacy and hemodynamic effects on total hip arthroplasty[J]. Rev Bras Anestesiol, 2009, 59:649-664. http://labs.europepmc.org/abstract/MED/20011855
    [10] Duarte LT, Paes FC, Fernandes MC, et al. Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty:a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine[J]. Rev Bras Anestesiol, 2009, 59:273-285. doi:  10.1590/S0034-70942009000300002
    [11] Marino J, Russo J, Kenny M, et al. Continuous lumbar plexus block for postoperative pain control after total hip arthroplasty. A randomized controlled trial[J]. J Bone Joint Surg Am, 2009, 91:29-37. doi:  10.2106/00004623-200908005-00027
    [12] 徐仲煌, 黄宇光, 潘华.罗哌卡因用于腰丛-坐骨神经联合阻滞的临床观察[J].临床麻醉学杂志, 2002, 18:235-238. http://www.cqvip.com/Main/Detail.aspx?id=37133771
    [13] Birnbaum K, Prescher A, Hepler KD. The sensory innervation of the hip joint:an anatomical study[J]. Surg Radiol Anat, 1997, 19:371-375. doi:  10.1007/BF01628504
    [14] Bogoch ER, Henke M, Mackenzie T, et al. Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty:a randomized controlled clinical trial[J]. J Arthroplasty, 2002, 17:398-401. doi:  10.1054/arth.2002.31079
    • 相关文章
    • 施引文献
  • 资源附件(0)
  • 加载中
WeChat 点击查看大图
表(2)
计量
  • 文章访问数:  171
  • HTML全文浏览量:  66
  • PDF下载量:  4
  • 被引次数: 0
出版历程
  • 收稿日期:  2011-08-09
  • 刊出日期:  2011-10-30

目录

    /

    返回文章
    返回
    友情链接: 国家卫生健康委员会 北京协和医院 中国医学科学院 学术不端检测系统 国际知识资源总库 中国知网 术语在线 中国全科医学
    地址：北京市东城区帅府园1号 北京协和医院老楼7号楼
    3层302室 《协和医学杂志》编辑部
    电话：010-69154261/4262
    E - mail：medj@pumch.cn
    mjpumch@126.com
    期刊网站版权所有：《协和医学杂志》编辑部
    京ICP备 11002662

    本系统由 北京仁和汇智信息技术有限公司 开发    百度统计

    x 关闭 永久关闭

    【温馨提醒】近日，《协和医学杂志》编辑部接到作者反映，有多名不法人员冒充期刊编辑发送见刊通知，鼓动作者添加微信，从而骗取版面费的行为。特提醒您，本刊与作者联系的方式均为邮件通知或电话，稿件进度通知邮箱为：mjpumch@126.com，编辑部电话为：010-69154261，请提高警惕，谨防上当受骗！如有任何疑问，请致电编辑部核实。谢谢！